Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Ownership (CHOW) Contract Supplier Notification Form New 92 46 0 Form and Instruction CMS-10169 Change of Ownership (CHOW) Contract Supplier Notification Form
Change of Ownership (CHOW) Purchaser Form New 111 111 0 Form and Instruction CMS-10169 Change of Ownership (CHOW) Purchaser Form
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Application for Suppliers (Form A) Removed 0 0 0 Form and Instruction CMS-10169 Application for Suppliers
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Bidding Form (Form B) Removed 0 0 0 Form and Instruction CMS-10169 Form B - Bidding Form
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C) Modified 4952 1651 0 Form and Instruction CMS-10169 Form C: QUARTERLY REPORT
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure Modified 390 160 0 Form and Instruction CMS-10169 CONTRACT SUPPLIER'S DISCLOSURE OF SUBCONTRACTORS
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Modified 14667 7333 0 Form and Instruction CMS-10169 Beneficiary Survey
Total burden requested under this ICR: 20212 9301 0  
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